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    PT help

    Can somebody please help me. I am looking for a physical therapist for my dad, who can go to his house for physical therapy. He has a C4-C5 SCI, for the past four years. He has limited function in arms and legs, but npt enough ot be able to sit or stand independantly. He has no hand function at all. About two years ago, he made many gains during his therapy and had started to take a couple of steps with a walker, but the he had pneumonia and went all the way backwards. He is 68 years old. He doesn't want to travel or get out of the house, so I was thinking if we can find a Physical Therapist or personal trainer for home, he might be able to gain some of it back. He lives in Somerset. If anyone knows of such a professional, please let me know. It will be self pay. Thanks so much and God bless!

    Comment


      I don't know the best way to find a PT in your area, and I don't know what state you live in... but if you go to www.apta.org they have "Find a PT'
      http://www.apta.org/apta/findapt/ind...ID=10737422525
      You can put in your zip code, and see a list of PTs. People with the title "NCS" mean "neurological clinical specialist" and contacting those local neuro PTs would be a good place to start.
      Good luck!
      Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

      Comment


        scifitness- I am recovering very well but have some lagging deficiencies. I was hoping to get your input.

        Issue one are my toes on my good side. They scrunch up. It makes it hard to stand on my toes. On my left foot, I can barely move my toes and I have very slight plantar flex and barely noticable dorsi flex. However my right leg is almost perfect except for the toes which really are a problem. My foot tends to slide toward the instep and I push against the inside of my shoe. I was wondering if some type of stretching my help this. My PT when I was at therapy didn't really offer any suggestion but we were more interested in other things at that time.

        Issue two is my left side. It seems that my abductors and outside stabilizers on my glutes are there but they are very weak. I try and try to work them but only know of a couple of exerises. I use an abductor machine at the gym and I walk sideways using a theraband as resistance. Can you think of any other ways to strengthen those muscles?

        I don't try to walk unassisted too much because I don't really think I am ready, but what is holding me back are those stabilizers. They affect my balance which affects my gait etc. I get around mostly with forearm crutches and am quite content to bide my time, but would like to focus on those muscles more during my work outs. Thanks

        Comment


          Yea, I have the same issues with the toes on my weak leg being bent every which way by the socks and shoes that cover them. How is your sensation? Fortunately, I can tell immediately when something is twisted or pressured and just take off the shoe and fix it up. I'll admit that I am concerned that one of these days I'll dislocate or break something just because there is so little structural support keeping them in place.

          One thing that worked for me on longer hikes was bandaids wrapped around each toe. It takes some figuring out, but with the right size bandaids you can set it up so that it acts almost as flexible splint that keeps your toes from getting thrown around in your shoe. I suppose athletic tape would work as well - be careful not to put it on too tight.

          Hope that helps.
          L2 incomplete with a pretty bad limp since 10/31/2011.

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            Toes are the bugger. I have little sensation in them. Only one moves. In the morning they are pointed into ballet toes although a career with the NY ballet is unlikely. At the end of one particular day I found blisters on my toes. Discovered that each shoe had had a balled up sock in the toe. Didn't even feel it. Since then, I'm ultra vigilent with my feet. Would love to have my toes back.

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              I have a weird sensation on the bottom of my feet, but pretty normal on the top. I can feel my toes mostly. My left (bad side) toes will bend if I am not careful. My right just scrunch like they are trying to grab the ground. I have ignored this up until now because quite frankly getting back in the verticle position and building my big muscles back up has been my priority and there aren't enough hours in the day to do EVERYTHING, so I have to pick and choose my battles and tackle the big challenges first. I am starting to be able to shift my focus a little and spend some time on these other issues. Thanks for your input. Judging by y'alls descriptions of your symptoms, we must all 3 be injured in similiar ways.

              Comment


                Toes are tough... and your concerns are valid. They could injure easily because there is little support. Band-aids are an interesting solution that I hadn't thought of - and are much simpler than the inserts I was going to suggest. Do you stretch the toes before applying the band-ands?

                There are orthotics that can help keep the toes straight. But it can be tough to find the one that works for you depending on how strong that flexion and making sure they don't cause blisters...

                Isolating the abductors - lay on your back, and do "snow angels", lay on your side and lift your straight leg up with a slightly posterior angle (this gets the gluteus medious, and it's easy to cheat with hip flexors if you don't lift up AND back) then in a crawling position, lift your leg out to the side (like a dog at a tree?)
                Try 2-3 sets of 10, and increase to 15 when you can. Good luck!
                Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                Comment


                  Thanks. As always your input is appreciated.

                  Comment


                    Oops, re-reding everything tells me that the band aids might not solve the problem. My toes are super relaxed all the time, rather than scrunched up and tense. I occasionally put bandaids on just to keep them properly oriented during strenuous hiking because they get bent in random directions. .

                    As for Mflounlacker's issue (I had originally thought he was talking about his weak and relaxed bad leg), his tight toes might be too rigid for bandaids to compensate against. But then again, maybe with enough stretching the tightness would relax enough for the bandaids to be of some use. At least it's pretty cheap to try it out.
                    L2 incomplete with a pretty bad limp since 10/31/2011.

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                      error'
                      Last edited by baldfatdad; 20 Sep 2012, 10:41 PM.

                      Comment


                        I am working hard on my balance and would like to know if there are any programs out there that are concentrating on this? Are there any studies that have taken a look at the efficacy of different techniques? I am currently doing what I call dynamic standing and bending. I stand with my legs in different positions and bend at the waist while trying to maintain my balance. I am also doing different types of bridges using a swiss ball, one leg, etc. to strengthen my lower back and glutes as well squats with one leg on a box. I have only been at this for a couple weeks now so it is too early to know if it is working. I use crutches fulltime and am afraid I may be letting my balance muscles off the hook too much. I don't want to hobble so I do very little walking unassisted. I have gone from wheelchair to walker to crutches in 10 months following T12 fracture disclocation. I know that I am doing great, but I want more. Sorry I am greedy.

                        Comment


                          Over the summer i spent a lot of time on a slack line (basically a stretchy tight rope). I ran another rope above the tightrope for stability when I needed it, but that became less and less frequent with practice, and practice absolutely destroyed my core, abductors and adductors (even when I was able bodied, a day on the slack line made me sore).

                          Your progression is not unlike mine, so if you happen to know of any slacklining hippies in your area, give it a shot - it's a lot easier than it looks when you have a rope to grab onto. But if not, I think surfing on your knees is already on the cutting edge. The only reason slacklining worked so well for me was because I enjoyed it and did it a lot, with the awesome balance workout being a nice benefit. Enjoying it and doing it a lot is ten times more effective than any special workout technique, in my opinion.

                          Sounds like surfing is a similar deal for you. You enjoy it, do it a lot and I imagine that it takes a lot of hip and core effort to keep stable. That will do wonders. One thing to consider is that maybe you should try hobbling around a bit, to whatever extent you can. I too avoid walking unaided most of the time and use a cane because the asymmetry in my unaided gait is bad news for joints and back muscles, but I definitely spend as much time as I can walking with nothing.

                          You're not going to get better on the balance without practicing a lot, even if it's ugly. I've only really started walking unaided in the past month or two and the balance improvement has been pretty drastic. Now I can walk around in a dark room no problem, for instance.

                          Good luck!
                          L2 incomplete with a pretty bad limp since 10/31/2011.

                          Comment


                            Good advice shveddy! I agree
                            Strengthening is very important to improve balance, and spending time challenging your balance is also beneficial.
                            I like the idea of challenging your balance with an activity - that would be fun. The slackline is interesting. Be safe! And protect your joints for the long haul. Keep working hard, and you will continue to see results. It has been quite the year for you.

                            As far as studies... nope. There is not much out there in the way of documented interventions. Now there are more locomotor training studies going on. But the big picture is that more research is needed so that more therapy can be covered by insurance! When we don't have numbers to back up our treatments, they don't get covered
                            Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                            Comment


                              SCI Total Fitness- Quick question if you don't mind.

                              It seeems that the locking mechanism in my knee is loose. It is hard to get to a spot where it stays flexed. When it gets right to the point of locking it either locks or gets loose. It is hard to describe. When it is locked it is solid and when it bends further it is solid. Any thoughts on how I can strengthen this?

                              Comment


                                Good question - I am sure many people with incomplete injuries have this issue.

                                When the knee is completely locked straight, you are relying on your joint structures more than you muscle strength. You're very stable here, but over time, you can wear on your ligaments. You don't want future issues arising, which is why this isn't recommended.

                                This can be happening for a few reasons (sorry!). One is strength. The quads are most responsible for knee position, so strengthening these are key. However, you also have the hamstrings and ITB which cross the knee, and unfortunately an imbalance of strength could contribute... and the hamstrings and ITB are generally weak/absent after many spinal injuries.

                                One is sensation. If your proprioception is impaired, your joint doesn't know where that "sweet spot" is. So it locks out to get extra input from the joint and ligaments, or bends more to get extra input from muscles.

                                Another is what is going on at your ankle - if you're lacking range in the ankle, the knee compensates.

                                And lastly, it could be what is going on at the hip - if you're weak, especially with hip extension, the knee will compensate.

                                As you can see, this is not a simple question that can be answered without an exam. I would recommend getting an evaluation from a local physical therapist to determine which of the above (an it could unfortunately be multifactorial ) is going on with you and how to best address it.
                                Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

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